Firstly, providers in Girl Power clinics were not judgemental and this helped the young women to open up and ask for the services; secondly, the Girl Power clinics were private and confidential; thirdly the experimental clinics kept flexible hours and were therefore more accessible than standard care; and finally, integrated services allowed young women to access all the services they needed without waiting in several separate queues. The presence of peer educators and the low cost of services were additional perks.
Early findings from the EMPOWER study looked at the use of empowerment clubs for young women using oral PrEP. In the experimental arm of the study, these clubs are offered at health facilities, in addition to standard care, as part of an HIV prevention package. The experiences of young women attending these classes, suggested that, by and large, the content was relevant and provided an important way of addressing social and structural issues as they transition into adulthood. It was evident that young women wanted to discuss and share tips and tricks to overcome side effects of PrEP, and the clubs were seen as valuable sources of peer support. Importantly, clubs created ongoing networks outside of the sessions. Useful lessons have already been learned about structuring club activities. For example, young women have busy lives and want fast, easy services, so offering sessions sequentially may not be the best strategy. Therefore, linking club sessions with clinic visits is more a more practical approach.
The Mzantsi Wakho study, which follows a cohort of over one thousand HIV-positive adolescents in the Eastern Cape, had fresh views on what is meant by adolescent-friendly care. Their research showed that inappropriate healthcare can have a big impact on adolescents by shaping feelings of self-stigma, or internalised stigma. Three factors were identified: inflexible clinic hours, unfriendly staff and drug stock-outs. For example, when young people miss school to attend inflexible clinic appointments, they feel different from other pupils; when clinic staffers scold them, they feel that they are to blame for their health condition; and when treatment is unavailable they are made to feel that their health and well-being are unimportant.
The research, however, reflected a fairly positive situation: over 60% of positive adolescents surveyed did have flexible appointment times, over 80% reported kind health care providers and over 90% of adolescents reported reliable drugs supplies. On the other hand, only 52.1% of benefited from all three supportive factors.